[Chronic low back pain and functional restoring program: applicability of the Patient Acceptable Symptom State].
OBJECTIVE
To search for predictors of reduced low back pain under the patient acceptable symptom state (PASS) at the end of a functional restoration program (FRP) in chronic low back pain, and then to compare the effectiveness of FRP depending on the rate of people returning to work, the acceptability threshold of pain has been reached or not at the end of the program.


METHODS
Open prospective study on 303 patients with chronic low back pain included in a FRP. An assessment of the deficiencies (finger-tip-to-floor (cm) and Schöber tests (cm), VO2max (l/min), Shirado and Sorensen tests (seconds), lumbar and radicular VAS (0-100), the functional disability (Wadell and Quebec scales (0-9 and 0-100), and the psychological status (Beck and Hamilton scale (0-35 and 0-30), HAD scale (0-21), FABQ (0-42 and 0-24)) was conducted at the beginning and end of the program. Data on the work were also collected (arduous physical labor, work-related accident or not, sick leaves or not and length, return to work at the end of the program). The variables associated with a PASS at the end of the FRP and a correlation between the level of pain and the return to work were sought.


RESULTS
The parameters were significantly improved: finger-tip-to-floor test (-17.5+/-16.2), Schöber test (-0.5+/-5.4), lumbar VAS(-6.3+/-23.6), VO2max (0.14+/-0.4), Wadell (-1.3+/-2.4), Quebec (-10.5+/-17), Beck D (-3.1+/-4.5), Beck A (-2.5+/-4.3), HAD D (-2.4+/-4.7), HAD A (-1.3+/-3.8) et FABQ1 (-5.7+/-11.6), FABQ2 (-3.9+/-9.6) scores, endurance of the flexor (35+/-63.83) and extensor (44.8+/-112) spine. Patients reaching the PASS for pain level return significantly more to work (73% versus 52%). Five parameters indicative of a reduction of back pain under the PASS were identified : lumbar VAS and endurance of the flexor spine at the beginning, changes in finger-tip-to-floor test, radicular VAS and Beck score for anxiety.


CONCLUSIONS
The PASS appears to be a relevant concept associated with a successful return to work for patients with chronic low back pain and severe disability after a program of FRP.
Véron
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Service de rééducation-réadaptation de l'appareil locomoteur et des pathologies du rachis, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France. olympeveron@yahoo.com
Tcherniatinsky
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E
Fayad
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F
Revel
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M
Poiraudeau
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S
D000328:Adult; D002908:Chronic Disease; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000523:psychology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009790:Occupations; D010808:Physical Examination; D015397:Program Evaluation; D011446:Prospective Studies; D011843:Radiculopathy / Q000523:psychology / Q000534:rehabilitation*; D020127:Recovery of Function; D012720:Severity of Illness Index; D013177:Sports; D016896:Treatment Outcome; D014938:Work Capacity Evaluation; D055815:Young Adult